Schedule 2

*pursuant to section 12(2B)(a): (Name of Respondent) is prohibited from doing the following thing(s) in relation to (name of applicant): [specify thing(s)](b)*pursuant to section 12(2B)(a): (Name of Respondent) is prohibited from doing the following thing(s) in relation to the related person(s) named below, being [a person/persons]* about whose safety or well‑being (name of applicant) would reasonably be expected to be seriously concerned: [specify related person(s) and thing(s) in relation to each named related person](c)*pursuant to section 12(2B)(b): (Name of Respondent) must stop publishing the following communication(s) or not publish any communication that is similar to the following communication(s): [specify particulars of the alleged offending communication(s)]2.A protection order under section 12(2E) providing that:

*+(Name of third party) must stop publishing (within the time specified by the court) or not publish the communication specified in paragraph 1(c) or any communication that is similar to that communication.

*+any third party must stop publishing (within the time specified by the court) or not publish the communication specified in paragraph 1(c) or any communication that is similar to that communication.3.*+A protection order under section 12(2F) providing that the internet intermediary must disable access by end‑users of its internet intermediary service provided in Singapore to the following material: [specify internet intermediary; its internet intermediary service; and the material to which access is to be disabled]4.*+A protection order under section 12(2G) providing that the administrator concerned must stop the communication specified in paragraph 1(c) or any identical copy of that communication from being published in Singapore at the online location administered by the administrator: [specify administrator; and name of online location]5.*An expedited protection order under section 13 in respect of the following orders: [specify for which of the above orders an expedited protection order is sought, e.g. the order mentioned in paragraph 1(a)]6.*Where the court makes a protection order under section 12(2) mentioned in paragraph 1, a mandatory treatment order under section 13B providing that (Name of Respondent) must undergo psychiatric treatment for a period not exceeding 36 months. Dated this day of 20 .Registrar.This summons is taken out by (name of applicant or applicant’s solicitor) whose address is (address of applicant or applicant’s solicitor).*Delete where inapplicable.+Repeat this Part if there is more than one person to whom the order under section 12(2E), (2F) or (2G) of the Protection from Harassment Act is to apply._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 2 Rule 53(1)AFFIDAVIT IN SUPPORT OF APPLICATION FOR PROTECTION ORDER [WITH EXPEDITED PROTECTION ORDER/MANDATORY TREATMENT ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]AFFIDAVITI, (name of applicant), the applicant, do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date] at [location] (through the interpretation of [name of interpreter]).EXHIBIT “A” INFORMATION IN SUPPORT OF APPLICATIONPart A — Applicant’s Particulars1.My particulars are as follows:

Name:

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:2.I am deposing this affidavit in my [own capacity/capacity as (state capacity)]*.Part B — Application for protection order against Respondent3.To the best of my knowledge, information and belief, the Respondent’s particulars are as follows:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:

Other electronic means of contacting the Respondent:

Relationship to me:4.To the best of my knowledge, information and belief, the Respondent has the following presence on the Internet:

Internet website address(es):

Blog (or weblog) address(es):

Account(s) on social media or social networking website(s):

Page(s) on social media or social networking website(s):5.I believe that the Respondent [is/is not]* in Singapore because [state reasons for the belief].6.The Respondent has contravened section(s) [3/4/5/6/7]* of the Protection from Harassment Act.7.The Respondent contravened the provision(s) of the Protection from Harassment Act mentioned in paragraph 6 by doing the following things: [specify how the Respondent has contravened the provisions mentioned in paragraph 6; specify whether the contravention involves an offending communication; specify whether the Respondent has been convicted of any offence under section 3, 4, 5, 6 or 7 of the Protection from Harassment Act or section 323, 324, 325, 326, 327, 329, 330, 331 or 333 of the Penal Code, in respect of the applicant] 8.The things which the Respondent did (as mentioned in paragraph 7) have the following effects on me or a related person: [specify the effects, in particular, any harassment, alarm, distress, injury or other harm caused]9.*The particulars of the offending communication(s) are as follows: [specify particulars of the alleged offending communication(s)]10.*The particulars of each publication by the Respondent of the offending communication (including the Internet location address of each publication on the Internet, if any) are as follows: [specify the particulars]11.*I attach the following evidence in support of my statements at paragraphs [6/7/8/9/10]*:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):12.I [have/have not]* approached the Respondent to remove the offending communication(s) mentioned in paragraph 9.

*The Respondent’s response to my approach was [describe Respondent’s response].

*I did not approach the Respondent because [state reasons].13.I believe that the Respondent —

*is likely to continue contravening the provision(s) of the Protection from Harassment Act mentioned in paragraph 6.

*is likely to commit a new contravention of section(s) [3/4/5/6/7]* of the Protection from Harassment Act.14.I attach the following evidence in support of my statement(s) at paragraph 13:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):15.I [have lodged a police report on [date] at [time]/have not lodged a police report]* in respect of the Respondent’s contravention of the provision(s) of the Protection from Harassment Act mentioned in paragraph 6.16.Medical attention [has/has not]* been sought in respect of any injury or harm specified in paragraph 8. [The particulars of the medical attention sought are as follows:

Date and time:

Receipt No. or Registration No.:

Diagnosis or Treatment: ]*+Part C — Application for expedited protection order against Respondent17.I believe that the Respondent is likely to continue or to commit the contraventions mentioned in paragraph 13 imminently.18.I believe that the continuation or commission of the contraventions mentioned in paragraph 13 is likely to have a substantial adverse effect on me or my day‑to‑day activities.+Part D — Application for mandatory treatment order against Respondent19.I am applying for a mandatory treatment order to be made against the Respondent under section 13B of the Protection from Harassment Act upon the Court granting my application for an order under section 12(2) of the Protection from Harassment Act against the Respondent.20.I believe the Respondent is suffering from a psychiatric condition which is likely to be a contributing factor for the Respondent’s conduct in paragraph 7 because [state reasons for the belief, identifying the psychiatric condition if possible].21.I attach the following evidence in support of my statement at paragraph 20:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):+Part E — Order under section [12(2E)/12(2F)/12(2G)]* of the Protection from Harassment Act22.I am applying for an order under section [12(2E)/12(2F)/12(2G)]* of the Protection from Harassment Act against a [third party/internet intermediary/administrator]*.23.To the best of my knowledge, information and belief, the [third party’s/internet intermediary’s/administrator’s]* particulars are as follows:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen), UEN or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:

*Other electronic means of contacting the [third party/internet intermediary/administrator]*:

Relationship to me:24.*To the best of my knowledge, information and belief, the third party has the following presence on the Internet:

*Internet website address(es):

*Blog (or weblog) address(es):

*Account(s) on social media or social networking website(s):

*Page(s) on social media or social networking website(s):25.*I believe that the [third party/internet intermediary/administrator]* [is/is not]* in Singapore because [state reasons for the belief].26.The particulars of each publication by the [third party/internet intermediary/administrator]* of the offending communication (including the Internet location address of each publication on the Internet, if any) are as follows: [specify the particulars]27.*I [have/have not]* approached the [third party/internet intermediary/administrator]* to remove the offending communication(s):

*The third party’s response to my approach was [describe third party’s response].

*I did not approach the third party because [state reasons].28.I believe that the third party is likely to publish, or continue to publish, the offending communication(s) or communication(s) that is similar to the offending communication(s).29.I attach the following evidence in support of my statement at paragraph 28:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):+Part F — Application for expedited protection order against third party/internet intermediary/administrator30.*I believe that the publication of the offending communication(s) [or communication(s) that is similar to the offending communication(s)]* by the third party is imminent or is likely to continue.31.*I believe that the publication of the offending communication(s) [or communication(s) that is similar to the offending communication(s)]* by the third party is likely to have a substantial adverse effect on me or my day‑to‑day activities.32.*I attach the following evidence in support of my statement(s) at paragraphs 30 and 31:Part G — Confirmation of Contents33.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true.Part H — Undertaking34.*I undertake to abide by any order the Court may make against me for the payment of damages to any person who sustains loss or damage by reason of my application for an expedited protection order or a mandatory treatment order in this matter.35.If I obtain any relevant information (that is, any document or information in the course of these proceedings which is subject to privilege or a duty of confidentiality, or any statement made or material disclosed to the party in the course of these proceedings or any record of these proceedings obtained under rule 73), I undertake —

to use the relevant information only in the conduct of those proceedings; and

to use the relevant information for any other purpose only with the permission of every party to the proceedings likely to be affected by the use of that material or with the permission of the court. [Signature of Applicant]Name of Applicant:Date:*Delete where inapplicable. Paragraphs 30, 31 and 32 are only applicable to an application for an expedited protection order.+Delete this Part if it is not required. Repeat this Part if there is more than one Respondent/third party/internet intermediary/administrator to whom the protection order is to apply._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 3 Rule 53(6)AFFIDAVIT IN REPLY TO APPLICATION FOR PROTECTION ORDER [WITH EXPEDITED PROTECTION ORDER/MANDATORY TREATMENT ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]AFFIDAVITI, (name), do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date] at [location] (through the interpretation of [name of interpreter]).EXHIBIT “A” RESPONSEPart A — Particulars of Respondent/third party/internet intermediary/administrator* to whom protection order is to apply1.My particulars are as follows:

Name:

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:2.I am deposing this affidavit in my [own capacity/in my capacity as (state capacity)]*:*Part B — Response of Respondent to application for protection order3.I am opposing the Applicant’s application for a protection order against me.4.A protection order should not be made against me because [state reasons].5.I attach the following evidence in support of my statements at paragraph 4:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):*Part C — Response of [Respondent/third party/internet intermediary/administrator]* to application for order under section [12(2E)/12(2F)/12(2G)]* of Protection from Harassment Act6.I am opposing the Applicant’s application for an order under section [12(2E)/12(2F)/12(2G)]* of the Protection from Harassment Act against me.7.An order under section [12(2E)/12(2F)/12(2G)]* of the Protection from Harassment Act should not be made against me because: [state reasons]8.I attach the following evidence in support of my statements at paragraph 7:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):*Part D — Response by Respondent against application for mandatory treatment order9.I am opposing the Applicant’s application for a mandatory treatment order against me.10.In the event that a protection order is granted against me, a mandatory treatment order should not be made against me because [state reasons].11.I attach the following evidence in support of my statements at paragraph 10:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):Part E — Confirmation of contents12.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true.Part F — Undertaking13.If I obtain any relevant information (that is, any document or information in the course of these proceedings which is subject to privilege or a duty of confidentiality, or any statement made or material disclosed to the party in the course of these proceedings or any record of these proceedings obtained under rule 73), I undertake —

to use the relevant information only in the conduct of those proceedings; and

to use the relevant information for any other purpose only with the permission of every party to the proceedings likely to be affected by the use of that material or with the permission of the court. [Signature of [Respondent/third party/internet intermediary/administrator]* to whom protection order is to apply]Name of [Respondent/third party/internet intermediary/administrator]* to whom protection order is to apply:Date:*Delete where inapplicable._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022]FORM 4Rule [54(1)/(2)]*[PROTECTION ORDER/EXPEDITED PROTECTION ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]Before the Honourable [District Judge/Protection from Harassment Court Judge]*[In Chambers/Open Court]*ORDER OF COURTUpon the application of (name of applicant), and upon reading the affidavit of (name of applicant) [and the affidavit(s) of (name of every Respondent or person who filed a response)]*, and upon hearing [, and upon the applicant undertaking to abide by any order the Court may make for the payment of damages by the applicant for loss or damage sustained by any person as a result of the applicant’s application for this order]#:It is ordered by the [District Judge/Protection from Harassment Court Judge]* as follows:1.*Protection order under section 12(2):

*pursuant to section 12(2B)(a): (Name of Respondent) is prohibited from doing the following thing(s) in relation to (name of applicant): [specify thing(s)](b)*pursuant to section 12(2B)(a): (Name of Respondent) is prohibited from doing the following thing(s) in relation to (name(s) of related person), being a person about whose safety or well‑being (name of applicant) would reasonably be expected to be seriously concerned: [specify thing(s)](c)*pursuant to section 12(2B)(b): (Name of Respondent) must stop publishing the following communication(s) within (the time specified by the court) or not publish any communication that is similar to the following communication(s): [specify particulars of the offending communication(s)](d)*pursuant to section 12(2B)(c): [names of Respondent/victim/related person of victim]* must attend [counselling/mediation]* by [particulars of body specified by the court].2.*Protection order under section 12(2E):

*(Name of third party) must stop publishing within (the time specified by the court) or not publish the communication specified in paragraph 1(c) or any communication that is similar to that communication.

*Any third party must stop publishing within (the time specified by the court) or not publish the communication specified in paragraph 1(c) or any communication that is similar to that communication.3.*Protection order under section 12(2F): (Name of internet intermediary) must within (the time specified by the court) disable access by end‑users of (name of its internet intermediary service) provided in Singapore to the following material: [specify the material to which access is to be disabled]4.*Protection order under section 12(2G): (Name of administrator) must within (the time specified by the court) stop the communication specified in paragraph 1(c) or any identical copy of that communication from being published in Singapore at (name of online location).5.*Expedited protection order under section 13: [specify expedited protection order(s) given]*Delete where inapplicable.#Include only if this is an expedited protection order under section 13.[S 405/2026 wef 29/06/2026]Important Message:1.You must carefully read, and comply with, the terms of this order.

If you disobey this order:a.you will be liable to process of execution to compel you to obey this order.b.you may also be guilty of contempt of court.c.you may also be guilty of an offence under section 10 of the Protection from Harassment Act which is punishable —

with a fine not exceeding $5,000 and/or an imprisonment term not exceeding 6 months;

for repeated offences under section 10 of the Act, with a fine not exceeding $10,000 and/or an imprisonment term not exceeding 12 months; or

with enhanced penalties under section 8(2), 8A(1)(b) or 8B(1)(b) of that Act.

If the party against whom this order is made is an entity, the word “you” in this paragraph may apply to its directors or other officers or partners (as the case may be).2.If this order is an expedited protection order, it cannot be appealed. However, the Court may vary, suspend or cancel this order on the application of —

the applicant;

any person to whom the order applies; or

where an expedited protection order requires an internet intermediary to disable access to a third party’s communication, or an administrator to stop the publication of a third party’s communication, that third party.3.[Deleted by S 193/2022 wef 01/04/2022]4.This order will take effect once it is served on you unless the Court specifies otherwise. If you were not identified as a person to whom the order applies when the order was made, you should be served a copy of the order together with a notification in Form 5.5.In this order and this message, “publish”, in relation to a communication or statement, means to make the communication or statement available, or to cause the communication or statement to be made available in any form such that the communication or statement is or can be heard, seen or otherwise perceived by the public in Singapore or a member of the public in Singapore, and includes cause to be published.6.This order ceases to have effect:

during any period when it is suspended by the Court;

when it expires;

when it is cancelled by the Court; or

if this order is an expedited protection order, when the application for the related protection order is determined or discontinued._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 5 Rule 54(3) and (4)NOTIFICATION TO RELEVANT PARTY NOT IDENTIFIED IN [PROTECTION ORDER/EXPEDITED PROTECION ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as Form 1]NOTIFICATION OF PARTICULARS OF OFFENDING COMMUNICATION +Preamble+This notification is intended to amend and replace the notification which was filed on [insert date and time of filing] and served on the relevant party in paragraph [3/5/6]*.Part A — Brief Particulars1.Particulars of offending communication:2.Particulars of publication of communication:Part B — Details of third party3.To the best of my knowledge, information and belief, the particulars of the third party (not identified in the order under section [12(2E)/13(1B)]* of the Protection from Harassment Act dated [insert date of order]) against whom the order applies are as follows:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:

Other electronic means of contacting the third party*:

Relationship to me:4.To the best of my knowledge, information and belief, the third party has the following presence on the Internet:

Internet website address(es):

Blog (or weblog) address(es):

Account(s) on social media or social networking website(s):

Page(s) on social media or social networking website(s):Part C — Details of Internet Intermediary5.To the best of my knowledge, information and belief, the particulars of the internet intermediary (for the purpose of section [12(2F)/13(1C)]* of the Protection from Harassment Act dated [insert date of order]) against whom the order applies are as follows:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen)/UEN (for Singapore‑registered entity) or No., type and country of issue of foreign identification document (for foreign citizen/entity):

Address for service:

Other electronic means of contacting the internet intermediary*:

Name of Internet Intermediary Service through which offending communication was published:

Nature of Internet Intermediary Service through which offending communication was published:Part D — Details of Administrator6.To the best of my knowledge, information and belief, the particulars of the administrator (for the purpose of section [12(2G)/13(1D)]* of the Protection from Harassment Act dated [insert date of order]) against whom the order applies are as follows:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen)/UEN (for Singapore-registered entity) or No., type and country of issue of foreign identification document (for foreign citizen/entity):

Address for service:

Other electronic means of contacting the administrator*:

Online location where offending communication was published:Part E — Details of offending communication7.The details of each publication by the third party of the offending communication (including the Internet location address of each publication on the Internet, if any) are as follows:8.I attach the following evidence in support of my statements at paragraphs 3, 4, 5, 6 and 7:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):9.I [have/have not]* approached the third party to remove the offending communication mentioned in paragraphs 1 and 2.

*The third party’s response to my approach was as follows:

*I did not approach the third party for the following reasons:10.I [have/have not]* approached the internet intermediary to remove the offending communication mentioned in paragraphs 1 and 2.

*The internet intermediary’s response to my approach was as follows:

*I did not approach the internet intermediary for the following reasons:11.I [have/have not]* approached the administrator to remove the offending communication mentioned in paragraphs 1 and 2.

*The administrator’s response to my approach was as follows:

*I did not approach the administrator for the following reasons:Part F — Confirmation of Contents12.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true. [Signature of Applicant]Name of Applicant:Date:*Delete where inapplicable.+Delete unless amending the notification pursuant to rule 54(5)._______________________[S 405/2026 wef 29/06/2026] FORM 6 Rule 55(1)(a)APPLICATION UNDER SECTION [12(7)/13(3A)]* OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]SUMMONSLet all parties concerned attend before the [District Judge/Protection from Harassment Court Judge]* on (date and time), on the hearing of an application by (name of person making application) for an order that:1.*The [protection order/expedited protection order]* made on (date) be varied as follows: [specify how the order is to be varied]2.*The [protection order/expedited protection order]* made on (date) be [[suspended/extended]* for a period of beginning on (date)/cancelled]*.3.The Court give such other direction(s) as the Court thinks fit.Dated this day of 20 .Registrar.This summons is taken out by (name of person making application or that person’s solicitor) whose address is .*Delete where inapplicable._______________________ FORM 7 Rule 55(1)(b)AFFIDAVIT IN SUPPORT OF APPLICATION UNDER SECTION [12(7)/13(3A)]* OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 6]AFFIDAVITI, (name of person making application), do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date] at [location] (through the interpretation of [name of interpreter]).EXHIBIT “A” INFORMATION IN SUPPORT OF APPLICATIONPart A — Particulars of person making application1.My particulars are as follows:

Name:

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:Part B — Information in support of application2.*I am applying for an order that the [protection order/expedited protection order]* made on (date) be varied as follows:3.*I am applying for an order that the [protection order/expedited protection order]* made on (date) be [[suspended/extended]* for a period of beginning on (date)/cancelled]*.4.The reasons for my application are as follows:Part C — Confirmation of Contents5.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true. [Signature of person making application]Name of person making application:Date:*Delete where inapplicable._______________________[S 193/2022 wef 01/04/2022] FORM 8 Rule 56(1)APPLICATION FOR FALSE STATEMENT ORDER [WITH INTERIM FALSE STATEMENT ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) In the matter of an application under section [15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act.And in the matter of (name of subject of relevant statement).Applicant.ORIGINATING APPLICATIONLet all parties concerned attend before the [District Judge/Protection from Harassment Court Judge]* on (date and time), on the hearing of an application by (name of applicant) for an order under section [15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act in respect of the relevant statement(s) set out in paragraph 1:1.[specify particulars of relevant statement(s)]2.*+Pursuant to section 15A: The Respondent [and any other persons]* must stop publishing the relevant statement and must not publish any similar statement: [specify the Respondent [and any other persons]* to which the stop publication order is to apply]2A.*+Pursuant to section 16A: an interim stop publication order in relation to the application for the stop publication order mentioned in paragraph 2: [specify the Respondent [and any other persons]* to which the interim stop publication order is to apply]2B.*+Pursuant to section 16B: The Respondent must publish the following interim notice in relation to the application for the stop publication order mentioned in paragraph 2: [specify the Respondent to which the interim notification order is to apply; the [person(s)/description of persons]* to whom the interim notice must be published; and the content, form and manner of the interim notice]3.*+Pursuant to section 15B: The Respondent must publish the following correction notice(s): [specify the Respondent to which the correction order is to apply; the [person(s)/description of persons]* to whom the correction notice must be published; and the content, form and manner of the correction notice]3A.*+Pursuant to section 16B: The Respondent must publish the following interim notice in relation to the application for the correction order mentioned in paragraph 3: [specify the Respondent to which the interim notification order is to apply; the [person(s)/description of persons]* to whom the interim notice must be published; and the content, form and manner of the interim notice]4.*+Pursuant to section 15C: The Respondent must disable access by end‑users of its internet intermediary service provided in Singapore to the following material [or identical copies of the following material]*: [specify the Respondent to which the disabling order is to apply; and the material to which access is to be disabled]4A.*+Pursuant to section 16AA: an interim disabling order in relation to the application for the disabling order mentioned in paragraph 4: [specify the Respondent to which the interim disabling order is to apply; and the material to which access is to be disabled]5.*+Pursuant to section 15CA: The Respondent must stop the publication in Singapore of the following material on the online location administered by the Respondent that consists of or contains the relevant statement, or any similar copy of the following material: [specify the Respondent to which the stop publication (administrator) order is to apply; and the material which publication is to be stopped]5A.*+Pursuant to section 16AB: an interim stop publication (administrator) order in relation to the application for the stop publication (administrator) order mentioned in paragraph 5: [specify the Respondent to which the interim stop publication (administrator) order is to apply]6.*+Pursuant to section 15CB: The Respondent must publish in Singapore the following correction (administrator) notice(s): [specify the Respondent to which the correction (administrator) order is to apply; the [person(s)/description of persons]* to whom the correction (administrator) notice must be published; and the content, form and manner of the correction (administrator) notice]6A.*+Pursuant to section 16BAA: The Respondent must publish in Singapore the following interim (administrator) notice in relation to the application for the correction (administrator) order mentioned in paragraph 6: [specify the Respondent to which the interim notification (administrator) order is to apply; the [person(s)/description of persons]* to whom the interim (administrator) notice must be published; and the content, form and manner of the interim (administrator) notice]7.*+Pursuant to section 15D: The Respondent must publish the following targeted correction notice to all end‑users in Singapore of its internet intermediary service who [access/it knows had accessed]* the following material [or identical copies of the following material]*: [specify the Respondent to which the targeted correction order is to apply; the material to which the end‑users have access that consists of or contains the relevant statement or identical copies of it; the content, form, and manner of the targeted correction notice]7A.*+Pursuant to section 16BA: The Respondent must publish the following targeted interim notice in relation to the application for the targeted correction order mentioned in paragraph 7: [specify the Respondent to which the targeted interim notification order is to apply; the end‑users to whom the targeted interim notice must be published; and the content, form and manner of the targeted interim notice]8.*+Pursuant to section 15E: The Respondent must publish in Singapore the following general correction notice: [specify the Respondent to which the general correction order is to apply; the content, form and manner of the general correction notice]9.The Court to give such other direction(s) as the Court thinks fit.Dated this day of 20 .Registrar.This summons is taken out by (name of applicant or applicant’s solicitor) whose address is .*Delete where inapplicable.+Repeat this Part if there is more than one person to whom the order under section 15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA of the Protection from Harassment Act is to apply._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 8A Rule 56(4)(b)APPLICATION FOR INTERIM FALSE STATEMENT ORDER UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in OS]And in the matter of an application under section [16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act.And in the matter of [name of subject of relevant statement].Applicant.SUMMONS [WITHOUT NOTICE]#Let all parties concerned attend before the [District Judge/Protection from Harassment Court Judge]* on [date and time], on the hearing of an application by [name of applicant] for an order under section [16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act in respect of the relevant statement(s) set out in paragraph 1:1.[specify particulars of relevant statement(s)]2.*+Pursuant to section 16A: The Respondent [and any other persons]* must stop publishing the relevant statement and must not publish any similar statement: [specify the Respondent [and any other persons]* to which the interim stop publication order is to apply]3.*+Pursuant to section 16AA: The Respondent must disable access by end‑users of its internet intermediary service provided in Singapore to the following material: [specify the Respondent [and any other persons]* to which the interim disabling order is to apply; and the material to which access is to be disabled]4.*+Pursuant to section 16AB: The Respondent must stop the publication in Singapore of the following material on the online location administered by the Respondent that consists of or contains the relevant statement, or any similar copy of the following material: [specify the Respondent to which the interim stop publication (administrator) order is to apply; and the material which publication is to be stopped]5.*+Pursuant to section 16B: The Respondent must publish the following interim notice: [specify the Respondent to which the interim notification order is to apply; the [person(s)/description of persons]* to whom the interim notice must be published; the content, form and manner of the interim notice]6.*+Pursuant to section 16BA: The Respondent must publish the following targeted interim notice to all end‑users in Singapore of its internet intermediary service who [access/it knows had accessed]* the following material [or identical copies of the following material]*: [specify the Respondent to which the targeted interim notification order is to apply; the material to which the end‑users have access that consists of or contains the relevant statement or identical copies of it; the content, form, and manner of the targeted interim notice]7.*+Pursuant to section 16BAA: The Respondent must publish in Singapore the following interim (administrator) notice: [specify the Respondent to which the interim notification (administrator) order is to apply; the [person(s)/description of persons]* to whom the interim (administrator) notice must be published; and the content, form and manner of the interim (administrator) notice]8.The Court to give such other direction(s) as the Court thinks fit.Dated this day of 20 .Registrar.This summons is taken out by (name of applicant or applicant’s solicitor) whose address is .#Delete if this includes an application under section 16AA or 16BA of the Act.*Delete where inapplicable. +Repeat this Part if there is more than one person to whom the order is to apply._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 9 Rule 56(1) and (4)(b)AFFIDAVIT IN SUPPORT OF APPLICATION FOR [FALSE STATEMENT ORDER/ INTERIM FALSE STATEMENT ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S./Summons No. ) of 20 . ) [Title as in Form 8]*AFFIDAVITI, [name of applicant], the applicant, do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date] at [location] (through the interpretation of [name of interpreter]).EXHIBIT “A” INFORMATION IN SUPPORT OF APPLICATIONPart A — Applicant’s Particulars1.My particulars are as follows:

Name:

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:2.I am deposing this affidavit in my [own capacity/capacity as (state capacity)]*.+Part B — Application for false statement order3.>Paragraphs [6 to 18]< relate to my application for an order under section [15A/15B/15C/15CA/15CB/15D/15E]* [and paragraphs [19 to 22]< relate to my application for an interim order under section [16A/16AA/16AB/16B/16BA/16BAA]*]* of the Protection from Harassment Act against the following person:4.To the best of my knowledge, information and belief, the person’s particulars are as follows:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:

Other electronic means of contacting the person:

Relationship to me:5.To the best of my knowledge, information and belief, the person has the following presence on the Internet:

Internet website address(es):

Blog (or weblog) address(es):

Account(s) on social media or social networking website(s):

Page(s) on social media or social networking website(s):6.I believe that the person [is/is not]* in Singapore because [state reasons for the belief]. 7.The particulars of the relevant statement are as follows: [specify particulars of the relevant statement]8.The relevant statement is about [me/the following subject]*:9.The originator of the relevant statement (the author) is the following person:10.I will be [able/unable]* to serve the originator of the relevant statement (the author) because:11.The relevant statement is a statement of fact about [me/the subject]* which is false in the following particular(s) about [me/the subject]*: [specify the particulars]12.The particulars of each publication by the person of the relevant statement (including the Internet location address of each publication on the Internet, if any) are as follows: [specify the particulars]13.I attach the following evidence in support of my statements at paragraphs 4 to 12:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):14.I [have/have not]* approached the person to remove or correct the relevant statement.

*The person’s response to my approach was as follows:

*I did not approach the person because: [state reasons]15.*Where the author of the relevant statement is not the person mentioned in paragraph 3, I [have/have not]* approached the author to remove or correct the relevant statement.

*The author’s response to my approach was as follows:

*I did not approach the author because: [state reasons]16.I attach the following evidence in support of my statement at paragraph [14/15]*:17.*I believe that the Respondent’s publication of the relevant statement(s) mentioned in paragraph 7 has caused or is likely to cause serious harm to my reputation: [specify the serious harm to your reputation caused or is likely to be caused by the publication of the relevant statement, and the reasons for your belief]18.*I attach the following evidence in support of my statement at paragraph 17:*+Part C — Application for interim false statement order19.I believe that the Respondent’s publication of the relevant statement(s) has caused or is likely to cause me harm.20.I attach the following evidence in support of my statement at paragraph 19:21.I believe it is just and equitable to grant the order on an expedited basis for the following reasons:22.I attach the following evidence in support of my statement at paragraph 21:Part D — Confirmation of Contents23.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true.Part E — Undertaking24.*I undertake to abide by any order the Court may make against me for the payment of damages to any person who sustains loss or damage by reason of my application for a false statement order or an interim false statement order in this matter.25.If I obtain any relevant information (that is, any document or information in the course of these proceedings which is subject to privilege or a duty of confidentiality, or any statement made or material disclosed to the party in the course of these proceedings or any record of these proceedings obtained under rule 73), I undertake —

to use the relevant information only in the conduct of those proceedings; and

to use the relevant information for any other purpose only with the permission of every party to the proceedings likely to be affected by the use of that material or with the permission of the court. [Signature of Applicant]Name of Applicant:Date:*Delete where inapplicable. Paragraphs 17 and 18 are only applicable to an application for a general correction order under section 15E of the Protection from Harassment Act. Paragraphs 19 to 22 are only applicable to an application for an interim false statement order under section 16A/16AA/16AB/16B/16BA/16BAA of the Protection from Harassment Act.>Repeat this paragraph in relation to each order applied for.<Substitute appropriate paragraph numbers.+Repeat this Part if there is more than one person to whom the order is to apply._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 10 Rule 56(6)AFFIDAVIT IN REPLY TO APPLICATION FOR [FALSE STATEMENT ORDER/INTERIM FALSE STATEMENT ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 9]AFFIDAVITI, [name], do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date&#93; at [location&#93; (through the interpretation of [name of interpreter&#93;).EXHIBIT “A” RESPONSEPart A — Particulars of Respondent1.My particulars are as follows:

Name:

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:2.I am deposing this affidavit in my [own capacity/capacity as (state capacity)]*:*>Part B — Response of Respondent to Application for [false statement order/interim false statement order]*3.I am opposing the Applicant’s [application for an order under section [15A/15B/15C/15CA/15CB/15D/15E]*/application for an interim order under section [16A/16AA/16AB/16B/16BA/16BAA]*]* of the Protection from Harassment Act against me.4.A [false statement order/interim false statement order]* should not be made against me because: [state reasons]5.I attach the following evidence in support of my statements at paragraph 4:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):Part C — Confirmation of Contents6.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true.Part D — Undertaking7.If I obtain any relevant information (that is, any document or information in the course of these proceedings which is subject to privilege or a duty of confidentiality, or any statement made or material disclosed to the party in the course of these proceedings or any record of these proceedings obtained under rule 73), I undertake —

to use the relevant information only in the conduct of those proceedings; and

to use the relevant information for any other purpose only with the permission of every party to the proceedings likely to be affected by the use of that material or with the permission of the court. [Signature of person named below]Name of [Respondent/third party/internet intermediary/administrator]* to whom protection order is to apply:Date:*Delete where inapplicable.>Repeat paragraphs 3, 4 and 5 for each false statement order/interim false statement order, if necessary._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 11 Rule 57(1)(a) and (2)(a)[FALSE STATEMENT ORDER/INTERIM FALSE STATEMENT ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) Form 11IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. ) of 20 . ) [Title as in Form 9]Before the Honourable [District Judge/Protection from Harassment Court Judge]*[In Chambers/In Open Court]*ORDER OF COURTUpon the application of [name of applicant], and upon reading the affidavit of [name of applicant] [and the affidavit of [name of person responding)]+, and upon hearing [, and upon the applicant undertaking to abide by any order the Court may make for the payment of damages by the applicant for loss or damage sustained by any person as a result of the applicant’s application for this order]#:It is ordered by the [District Judge/Protection from Harassment Court Judge]* as follows:1.The following statement(s) of fact about [name of subject] [is/are]* declared to be false: [specify particulars of statement(s)]*+2.Pursuant to section [15A/16A]*: The Respondent [and any other persons]* must stop publishing within [time specified by the court] the relevant statement and must not publish any similar statement: [specify the Respondent and any other persons to which the interim stop publication order/stop publication order is to apply]*+3.Pursuant to section 15B: The Respondent must publish the following correction notice(s) within [time specified by the court]: [specify the Respondent to which the correction order is to apply; the [person(s)/description of persons]* to whom the correction notice must be published; and the content, form and manner of the correction notice]*+4.Pursuant to section [15C/16AA]*: The Respondent must disable access by end‑users of its internet intermediary service provided in Singapore to the following material [or identical copies of the following material]* within [time specified by the court]: [specify the Respondent to which the [interim disabling order/disabling order]* is to apply; and the material to which access is to be disabled]*+5.Pursuant to section [15CA/16AB]*: The Respondent must within [time specified by the court] stop the publication in Singapore of the following material on the online location administered by the Respondent that consists of or contains the relevant statement, or any similar copy of the following material: [specify the Respondent to which the [interim stop publication (administrator) order/stop publication (administrator) order]* is to apply; and the material which publication is to be stopped]”*+6.Pursuant to section 15CB: The Respondent must publish in Singapore the following correction (administrator) notice(s) within [time specified by the court]: [specify the Respondent to which the correction (administrator) order is to apply; the [person(s)/description of persons]* to whom the correction (administrator) notice must be published; and the content, form and manner of the correction (administrator) notice]*+7.Pursuant to section 15D: The Respondent must publish the following targeted correction notice to all end‑users in Singapore of its internet intermediary service who [access/it knows had accessed]* the following material [or identical copies of the following material]* [from/by]* [time specified by the court]: [specify the Respondent to which the targeted correction order is to apply; the material to which the end‑users have access that consists of or contains the relevant statement or identical copies of it; and the content, form, and manner of the targeted correction notice]*+8.Pursuant to section 15E: The Respondent must publish in Singapore the following general correction notice within [time specified by the court]: [specify the Respondent to which the general correction order is to apply; and the content, form and manner of the general correction notice]*+9.Pursuant to section 16B: The Respondent must publish in Singapore the following interim notice within [time specified by the court]: [specify the Respondent to which the interim notification order is to apply; the [person(s)/description of persons]* to whom the interim notice must be published; and the content, form and manner of the interim notice]*+10.Pursuant to section 16BA: The Respondent must publish in Singapore the following targeted interim notice to all end‑users in Singapore of its internet intermediary service who [access/it knows had accessed]+* the following material [or identical copies of the following material]* [from/by]* [time specified by the court]: [specify the Respondent to which the targeted interim notification order is to apply; the material to which the end‑users have access that consists of or contains the relevant statement or identical copies of it; and the content, form, and manner of the targeted interim notice]*+11.Pursuant to section 16BAA: The Respondent must publish in Singapore the following interim (administrator) notice within [time specified by the court]: [specify the Respondent to which the interim notification (administrator) order is to apply; the [person(s)/description of persons]* to whom the interim (administrator) notice must be published; and the content, form and manner of the interim (administrator) notice]*12.

This order does not apply to the following person(s): [specify person(s)] (b) [specify any other exception(s) to this order]*+13.This order is subject to the following condition(s): [specify any other condition(s) to which this order is subject]*+14.[specify any direction(s) given by the Court]. Dated this day of 20 .Important Message:1.You must carefully read, and comply with, the terms of this order.

If you disobey this order:a.you will be liable to process of execution to compel you to obey this order.b.you may also be guilty of contempt of court.

If the party against whom this order is made is an entity, the word “you” in this paragraph may apply to its directors or other officers or partners (as the case may be).2.If this order is an interim false statement order, it cannot be appealed against. However, the Court may vary, suspend or cancel this order on the application of —

the subject or author of the relevant statement;

the respondent; or

an individual or entity that published the relevant statement.3.[Deleted by S 193/2022 wef 01/04/2022]4.This order will take effect once it is served on you unless the Court specifies otherwise. If you were not identified in the order as a person to whom the order applies when the order was made, you should be served a copy of the order together with a notification in Form 12.5.In this order and this message, “publish”, in relation to a communication or statement, means to make the communication or statement available, or to cause the communication or statement to be made available, in any form such that the communication or statement is or can be heard, seen or otherwise perceived by the public in Singapore or a member of the public in Singapore, and includes cause to be published.6.This order ceases to have effect:

during any period when it is suspended by the Court;

when it expires; or

when it is cancelled by the Court._______________________*Delete where inapplicable.+Repeat this Part if there is more than one person to whom the order is to apply.#Include only if this is an interim false statement order under section 16A/16AA/16AB/16B/16BA/16BAA of the Protection from Harassment Act. [S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 12 Rule 57(3) and (4)NOTIFICATION TO RELEVANT PARTY NOT IDENTIFIED IN [STOP PUBLICATION ORDER/INTERIM STOP PUBLICATION ORDER]* UNDER PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. ) of 20 . ) [Title as in Form 9]Applicant.NOTIFICATION OF PARTICULARS OF RELEVANT STATEMENT AND PUBLICATION OF THAT STATEMENT+Preamble+This notification is intended to amend and replace the notification which was filed on [insert date and time of filing] and served on the relevant party in paragraph 6.Part A — Brief Particulars of Order under section [15A/16A]* of the Protection from Harassment Act1.Respondent(s):2.Date Order was made:3.[State paragraph(s) of the Order to apply to individual or entity mentioned in Part B] Pursuant to section 15A: The Respondent(s) [and any other persons]* must stop publishing the relevant statement and must not publish any similar statement within [time specified by court].4.Particulars of relevant statement:5.Particulars of publication of relevant statement:Part B — Details of relevant party6.To the best of my knowledge, information and belief, the Order described in Part A applies to the following person:

Name or, if the name is unknown, Unique Identifier (e.g. Internet location address, website, username or account or email address):

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:

Other electronic means of contacting the person:

Relationship to me:7.To the best of my knowledge, information and belief, the person has the following presence on the Internet:

Internet website address(es):

Blog (or weblog) address(es):

Account(s) on social media or social networking website(s):

Page(s) on social media or social networking website(s):8.To the best of my knowledge, information and belief, the person has published the relevant statement as follows: [Specify the particulars of the publication, including the Internet location address of each publication on the Internet, if any]9.I attach the following evidence in support of my statements at paragraphs 6, 7 and 8:

Document(s):

Photograph(s):

Other evidence (including electronic documents or records):10.I [have/have not]* approached the person to remove or correct the relevant statement:*(a)The person’s response to my approach was as follows:*(b)I did not approach the person for the following reasons:Part C — Confirmation of Contents11.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true. [Signature of Applicant]Name of Applicant:Date:*Delete where inapplicable. +Delete unless amending the notification pursuant to rule 57(5)._______________________[S 405/2026 wef 29/06/2026] FORM 13 Rule 58(1)(a)APPLICATION UNDER SECTION [15(5)/16(6)]* OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. ) of 20 . ) [Title as in Form 9]And in the matter of [Court Order No.]SUMMONSLet all parties concerned attend before the [District Judge/Protection from Harassment Court Judge]* on [date and time], on the hearing of an application by [name of person making application] for an order that:*1.The order under section [15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act made on (date) be varied as follows: [specify how the order is to be varied]*2.The order under section [15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act made on (date) be [suspended for a period of beginning on (date)/cancelled]*.*3.The Court give such other direction(s) as the Court thinks fit. Dated this day of 20 .Registrar.This summons is taken out by (name of person making application or that person’s solicitor) whose address is .*Delete where inapplicable._______________________[S 405/2026 wef 29/06/2026] FORM 14 Rule 58(1)(b)AFFIDAVIT IN SUPPORT OF APPLICATION UNDER SECTION [15(5)/16(6)]* OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 13]AFFIDAVITI, (name of person making application), do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date&#93; at [location&#93; (through the interpretation of [name of interpreter&#93;).EXHIBIT “A”INFORMATION IN SUPPORT OF APPLICATIONPart A — Particulars of person making application1.My particulars are as follows:

Name:

NRIC No. (for Singapore citizen) or No., type and country of issue of foreign identification document (for foreign citizen):

Address for service:2.I am deposing this affidavit in my [own capacity/capacity as (state capacity)]*:Part B — Information in support of application*3.I am applying for an order that the order under section [15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act made on (date) be varied as follows:*4.I am applying for an order that the order under section [15A/15B/15C/15CA/15CB/15D/15E/16A/16AA/16AB/16B/16BA/16BAA]* of the Protection from Harassment Act made on (date) be [suspended for a period of beginning on (date)/cancelled]*.5.The reasons for my application are as follows: [specify details for reasons]Part C — Confirmation of Contents6.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true. [Signature of person making application]Name of person making application:Date:*Delete where inapplicable._______________________[S 405/2026 wef 29/06/2026][S 193/2022 wef 01/04/2022] FORM 15 Rule 63(1)ORDER UNDER SECTION 13B(6) OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]Before the Honourable [District Judge/Protection from Harassment Court Judge]*[In Chambers/In Open Court]*ORDER OF COURTWhereas a protection order (specify Court Order No.) has been made against (name of respondent) upon the application of (name of applicant), Upon [the Court’s own initiative/the application of (name of applicant) for a mandatory treatment order]*,[And upon reading the affidavit of (name of applicant) [and the affidavit of (name of respondent)]*]*, and upon hearing [ ], [and upon the applicant undertaking to abide by any order the Court may make for the payment of damages by the applicant for loss or damage sustained by any person as a result of the applicant’s application]*It is ordered by the [District Judge/Protection from Harassment Court Judge]* that:Pursuant to section 13B(6), the Respondent must attend before a specified psychiatrist for the preparation of a preliminary assessment report and, for this purpose, attend personally at [Venue] on [Date] at [Time], and such other times and places as the specified psychiatrist may require.Important Message:1.You must obey this order. If you fail to obey this order, you may be liable for contempt of court.2.Please arrive at the venue at least 15 minutes before the scheduled time.*Delete where inapplicable._______________________ FORM 16 Rule 64(1)ORDER UNDER SECTION 13B(7) OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]Before the Honourable [District Judge/Protection from Harassment Court Judge]*[In Chambers/In Open Court]* ORDER OF COURTWhereas a protection order [specify Court Order No.] has been made against (name of respondent) upon the application of (name of applicant), Upon [the Court’s own initiative/the application of (name of applicant) for a mandatory treatment order]*,*[And upon reading the affidavit of (name of applicant) [and the affidavit of (name of respondent)]*, and upon hearing [ ], [and upon the applicant undertaking to abide by any order the Court may make for the payment of damages by the applicant for loss or damage sustained by any person by reason of the applicant’s application]*:It is ordered by the [District Judge/Protection from Harassment Court Judge]* that:1.pursuant to section 13B(7), the Respondent must [reside in a psychiatric institution for observation for [specify period]/attend personally before the appointed psychiatrist at a psychiatric institution* at such times as the appointed psychiatrist may require] for the preparation of a formal assessment report.2.*[any report by a psychiatrist engaged by the Respondent be filed and submitted to the appointed psychiatrist by [date]].Important Message:1.You must obey this order. If you fail to obey this order, including any notice requiring you to attend before an appointed psychiatrist, you may be liable for contempt of court.2.If you wish to submit a report by another psychiatrist, engaged by you, the report must be filed within 3 weeks after the date the court calls for the formal assessment report, unless the court allows you to do so by a later time.*Delete where inapplicable._______________________FORM 17Rule 65(1)MANDATORY TREATMENT ORDER UNDER SECTION 13B OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE O.S. No. )of 20 . ) [Title as in Form 1]Before the Honourable [District Judge/Protection from Harassment Court Judge]*[In Chambers/ In Open Court]*ORDER OF COURTWhereas a protection order (specify Court Order No.) has been made against (name of respondent) upon the application of (name of applicant), Upon [the Court’s own initiative/the application of (name of applicant)] for a mandatory treatment order]*,And upon reading the formal assessment report by the appointed psychiatrist certifying the matters mentioned in section 13B(8)[(a)/(b)/(c)]* of the Protection from Harassment Act [and the affidavit of (name of applicant)]* [and the affidavit of (name of respondent)]* [and the report of the psychiatrist submitted by the respondent under section 13B(11) of the Protection from Harassment Act]*, and upon hearing [ ],And upon explaining to the Respondent the purpose, effect, and consequences which may follow if any obligations or conditions of a mandatory treatment order are not met and the power of the Court to vary or revoke the order on application of the appointed psychiatrist,It is ordered by the [District Judge/Protection from Harassment Court Judge]* that:1.pursuant to section 13B(1), the Respondent must undergo psychiatric treatment for [a period not exceeding 36 months from the date this order is first in force].2.pursuant to section 13B(2), the Respondent must reside in a psychiatric institution for [the whole duration/[specify duration]]* of the psychiatric treatment.3.*[Insert any other conditions or requirements]Important Message:1.You must obey this order. This includes attending the treatment session(s) on such day(s) and at such time(s) and place(s) as the appointed psychiatrist may require, and complying with all other obligations and conditions imposed in connection with your treatment as the appointed psychiatrist may require. If you fail to obey this order, you may be liable for contempt of court.2.You must also bring this order and the Annex to your first treatment session.3.The Court has the power to vary or revoke this order on the application of the appointed psychiatrist.*Delete where inapplicable. Annex to Mandatory Treatment OrderFormal Assessment Report No: [insert number]Appointed Psychiatrist: [Name of Appointed Psychiatrist]I, [Name of Appointed Psychiatrist], have explained the requirements of the mandatory treatment order to the Respondent and I am satisfied that the Respondent understands them. ____________________Appointed Psychiatrist I, [Name of Respondent], hereby acknowledge that I have received a copy of my mandatory treatment order and that I am aware of the requirements of my mandatory treatment order, which have been explained to me.____________________Respondent_______________________ FORM 18 Rule 65(2)APPLICATION UNDER SECTION 13B(18) OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE Summons No. )of 20 . ) [Title as in Form 17]BetweenAppointed Psychiatrist.AndRespondentAndApplicant*SUMMONSLet all parties concerned attend before the [District Judge/Protection from Harassment Court Judge]* on [date and time], on the hearing of an application by the appointed psychiatrist, [name of appointed psychiatrist]:1.*[pursuant to section 13B(18), to revoke the mandatory treatment order made on (date).]2.*[pursuant to section 13B(18), to vary the mandatory treatment order made on (date) as follows [specify how the order is to be varied]:] Dated this day of 20 .Registrar.This summons is taken out by the appointed psychiatrist whose address is [insert address of psychiatric institution].*Delete where inapplicable._______________________ FORM 19 Rule 65(2)AFFIDAVIT IN SUPPORT OF APPLICATION UNDER SECTION 13B(18) OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE Summons No. )of 20 . ) [Title as in Form 17]BetweenAppointed Psychiatrist.AndRespondentAndApplicant*AFFIDAVITI, [name of appointed psychiatrist], do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date&#93; at [location&#93; (through the interpretation of [name of interpreter&#93;).EXHIBIT “A” INFORMATION IN SUPPORT OF APPLICATION1.I am the appointed psychiatrist with whom the respondent in this case has been ordered to undergo psychiatric treatment.2.I wish to apply to [vary/revoke]* the mandatory treatment order made on (date).3.*I wish for the abovementioned mandatory treatment order to be varied as follows: [specify variation applied for]4.My reasons for this application are as follows:□There has been a change in the circumstances after the order was made. [specify details of the change]:□The Respondent has made progress in psychiatric treatment. [specify progress made]:5.I attach the following evidence in support of my application:Confirmation of Contents6.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true. [Signature of Appointed Psychiatrist] Name of Appointed Psychiatrist: Date:*Delete where inapplicable. Paragraph 3 applies only if you are applying for a variation. _______________________[S 193/2022 wef 01/04/2022] FORM 20 Rule 65(4)AFFIDAVIT IN RESPONSE TO APPLICATION UNDER SECTION 13B(18) OF PROTECTION FROM HARASSMENT ACT (CHAPTER 256A) IN THE STATE COURTS OF THE REPUBLIC OF SINGAPORE Summons No. )of 20 . ) [Title as in Form 17]BetweenAppointed Psychiatrist.AndRespondentAndApplicant*AFFIDAVITI, (name of Applicant/Respondent), do make oath (or affirm) and say that the statements contained in the document exhibited and marked “A” are true.Sworn (or affirmed) on [date&#93; at [location&#93; (through the interpretation of [name of interpreter&#93;).EXHIBIT “A” INFORMATION [IN SUPPORT/OPPOSITION]* OF APPLICATION1.I am the [Applicant/Respondent]* in this case.2.The appointed psychiatrist, with whom the respondent in this case has been ordered to undergo psychiatric treatment, has filed an application to [vary/revoke]* the mandatory treatment order made on [insert date].3.I [support/oppose]* the application for the following reasons: [state details for your reasons]:4.I attach the following evidence in support of my response:Confirmation of Contents5.I confirm that to the best of my knowledge, information and belief, the information contained in this document is true. [Signature of Applicant/Respondent] Name of [Applicant/Respondent]*: Date:*Delete where inapplicable._______________________[S 193/2022 wef 01/04/2022] FORM 21 Rule 53(3)*/56(3)*MEMORANDUM OF SERVICE [Title as in action]Date: To: The Registrar The [originating application/summons/affidavit/[other document]]* herein was served on — Name of person served: Capacity in which person was served: [The Respondent or as the case may be]. On: [Day, date and time of service]. At: [Place of service]. Method of service: [State how service effected]. *Issued by: [Solicitors for the ].*Delete where inapplicable._______________________[S 193/2022 wef 01/04/2022]